Next-generation atrial fibrillation ablation: clinical performance of pulsed-field ablation and very high-power short-duration radiofrequency.
Comparison
Electroporation
High-power short duration
Pulmonary vein isolation
Single-shot ablation
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
13 Jul 2024
13 Jul 2024
Historique:
received:
13
03
2024
accepted:
19
06
2024
medline:
13
7
2024
pubmed:
13
7
2024
entrez:
12
7
2024
Statut:
aheadofprint
Résumé
Pulsed-field energy (PFA) and very high-power short-duration radiofrequency (vHPSD-RF) are two novel ablation methods for pulmonary vein isolation (PVI). Both PFA and vHPSD-RF show promise for improving efficacy, safety, and reducing procedure durations. However, direct comparisons between these two techniques are scarce. Retrospective analysis of 82 patients with symptomatic AF. Of these, 52 patients received PFA and 30 received vHPSD-RF (90 W, 4 s) as index procedure. At the 6-month follow-up, AF recurrence occurred in 4 patients following PFA and 5 patients following vHPSD-RF (p-value = 0.138). Significant improvements in the EHRA and NYHA stages were evident in both PFA (p < 0.001 and p = 0.047, respectively) and vHPSD-RF groups (p = 0.007 and p = 0.012, respectively). The total procedure duration and the left atrial dwell time were significantly shorter in the PFA group (64 ± 19 min vs. 99 ± 32 min, p < 0.001 and 41 ± 12 min vs. 62 ± 29 min, p < 0.001, respectively). The fluoroscopy time and dose area product were significantly higher in PFA (14 ± 6 vs. 9 ± 5 min, p < 0.001 and 14 ± 9 vs. 11 ± 9 Gy cm Based on this retrospective single-center study, PFA and vHPSD-RF were associated with similar effectiveness and safety profiles. PFA was linked to shorter procedure times and higher radiation exposure compared to vHPSD-RF.
Identifiants
pubmed: 38997610
doi: 10.1007/s10840-024-01853-4
pii: 10.1007/s10840-024-01853-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Hindricks G, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373–498. https://doi.org/10.1093/eurheartj/ehaa612 .
doi: 10.1093/eurheartj/ehaa612
pubmed: 32860505
Zipes DP, Jalife J, Stevenson WG. Cardiac electrophysiology: from cell to bedside E-Book. Elsevier Health Sciences; 2017.
Calkins H, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20(1):e1–160. https://doi.org/10.1093/europace/eux274 .
doi: 10.1093/europace/eux274
pubmed: 29016840
Perez JJ, et al. Low-energy (360 J) radiofrequency catheter ablation using moderate power - short duration: proof of concept based on in silico modeling. J Interv Card Electrophysiol. 2023;66(5):1085–93. https://doi.org/10.1007/s10840-022-01292-z .
doi: 10.1007/s10840-022-01292-z
pubmed: 35796934
Bourier F, et al. High-power short-duration versus standard radiofrequency ablation: insights on lesion metrics. J Cardiovasc Electrophysiol. 2018;29(11):1570–5. https://doi.org/10.1111/jce.13724 .
doi: 10.1111/jce.13724
pubmed: 30168230
Koruth J, et al. Preclinical evaluation of pulsed field ablation: electrophysiological and histological assessment of thoracic vein isolation. Circ Arrhythm Electrophysiol. 2019;12(12):e007781. https://doi.org/10.1161/CIRCEP.119.007781 .
doi: 10.1161/CIRCEP.119.007781
pubmed: 31826647
pmcid: 6924932
Reddy VY, et al. Pulsed field ablation of paroxysmal atrial fibrillation: 1-year outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol. 2021;7(5):614–27. https://doi.org/10.1016/j.jacep.2021.02.014 .
doi: 10.1016/j.jacep.2021.02.014
pubmed: 33933412
Turagam MK, et al. Safety and effectiveness of pulsed field ablation to treat atrial fibrillation: one-year outcomes from the MANIFEST-PF Registry. Circulation. 2023;148(1):35–46. https://doi.org/10.1161/CIRCULATIONAHA.123.064959 .
doi: 10.1161/CIRCULATIONAHA.123.064959
pubmed: 37199171
Richard Tilz R, et al. Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study. Int J Cardiol Heart Vasc. 2021;35:100847. https://doi.org/10.1016/j.ijcha.2021.100847 .
doi: 10.1016/j.ijcha.2021.100847
pubmed: 34381869
pmcid: 8333145
Heeger CH, et al. Very high-power short-duration ablation for pulmonary vein isolation utilizing a very-close protocol-the FAST AND FURIOUS PVI study. Europace. 2023;25(3):880–8. https://doi.org/10.1093/europace/euac243 .
doi: 10.1093/europace/euac243
pubmed: 36546582
Reddy VY, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation. J Am Coll Cardiol. 2019;74(3):315–26. https://doi.org/10.1016/j.jacc.2019.04.021 .
doi: 10.1016/j.jacc.2019.04.021
pubmed: 31085321
Urbanek L, et al. Pulsed field versus cryoballoon pulmonary vein isolation for atrial fibrillation: efficacy, safety, and long-term follow-up in a 400-Patient Cohort. Circ Arrhythm Electrophysiol. 2023;16(7):389–98. https://doi.org/10.1161/CIRCEP.123.011920 .
doi: 10.1161/CIRCEP.123.011920
pubmed: 37254781
Badertscher PA-O, et al. Efficacy and safety of pulmonary vein isolation with pulsed field ablation vs. novel cryoballoon ablation system for atrial fibrillation. LID - euad329 [pii] LID. https://doi.org/10.1093/europace/euad329 . (1532–2092 (Electronic)).
Reddy VY, et al. Pulmonary vein isolation with very high power, short duration, temperature-controlled lesions: the QDOT-FAST Trial. JACC Clin Electrophysiol. 2019;5(7):778–86. https://doi.org/10.1016/j.jacep.2019.04.009 .
doi: 10.1016/j.jacep.2019.04.009
pubmed: 31320006
Njoku A, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. Europace. 2018;20(1):33–42. https://doi.org/10.1093/europace/eux013 .
doi: 10.1093/europace/eux013
pubmed: 28444307
Aldaas OM, et al. Pulsed field ablation versus thermal energy ablation for atrial fibrillation: a systematic review and meta-analysis of procedural efficiency, safety, and efficacy. J Interv Card Electrophysiol. 2023. https://doi.org/10.1007/s10840-023-01660-3 .
doi: 10.1007/s10840-023-01660-3
pubmed: 37855992
pmcid: 11016003
Wormann J, et al. Comparison of pulsed-field ablation versus very high power short duration-ablation for pulmonary vein isolation. J Cardiovasc Electrophysiol. 2023;34(12):2417–24. https://doi.org/10.1111/jce.16101 .
doi: 10.1111/jce.16101
pubmed: 37846194
Reddy VY, et al. Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation. N Engl J Med. 2023;389(18):1660–71. https://doi.org/10.1056/NEJMoa2307291 .
doi: 10.1056/NEJMoa2307291
pubmed: 37634148
Ekanem E, et al. Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF). Europace. 2022;24(8):1256–66. https://doi.org/10.1093/europace/euac050 .
doi: 10.1093/europace/euac050
pubmed: 35647644
pmcid: 9435639
Bourier F, Sommer P. The shorter, the better?: Short duration ablation, catheter stability, and lesion durability. JACC Clin Electrophysiol. 2020;6(8):986–8. https://doi.org/10.1016/j.jacep.2020.05.001 .
doi: 10.1016/j.jacep.2020.05.001
pubmed: 32819534
Tilz RR, et al. A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: the POTTER-AF study. Eur Heart J. 2023;44(27):2458–69. https://doi.org/10.1093/eurheartj/ehad250 .
doi: 10.1093/eurheartj/ehad250
pubmed: 37062040
pmcid: 10344651